Amputation rates increased among US adult opioid-related hospitalizations from 2016 to 2022, with steeper increases than those observed among nonopioid-related hospitalizations, according to a brief research report published in Annals of Internal Medicine.
In a repeated cross-sectional analysis of the National Inpatient Sample, researchers evaluated more than 41 million adult hospitalizations, representing about 205 million weighted hospitalizations nationally. Opioid-related hospitalizations were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes, and amputations were identified using procedure codes recorded during the same hospitalization. Because opioid-related diagnoses and amputations were identified from codes recorded during the same hospitalization, the study could not determine whether opioid use directly caused the amputation.
Overall, 3% of hospitalizations were opioid related. Crude amputation rates among opioid-related hospitalizations increased from 56 to 92 per 10,000 hospitalizations from 2016 to 2022. Among nonopioid-related hospitalizations, rates increased from 59 to 80 per 10,000 hospitalizations. Despite the increase, amputations remained uncommon, occurring in fewer than 1% of opioid-related hospitalizations in 2022.
After adjustment for age, sex, race and ethnicity, diabetes, and peripheral vascular disease, the increase in amputation rates was 13 additional amputations per 10,000 hospitalizations greater among opioid-related hospitalizations than among nonopioid-related hospitalizations.
In adjusted analyses, the excess increase was statistically evident nationally and in the Northeast and West census regions. Estimates in other regions and census divisions generally moved in the same direction but were less precise.
Amputation level also differed by hospitalization type. Compared with nonopioid-related hospitalizations, opioid-related hospitalizations involved a greater proportion of upper-extremity amputations and amputations at the knee or above, lower leg, and other higher anatomical levels, whereas nonopioid-related hospitalizations more often involved the toe or part of the foot.
The researchers noted that contamination of street opioids with xylazine may be one contributor in areas where xylazine is more prevalent, although xylazine exposure was not measured in the data. The study also pointed to other possible contributors, including increased injection frequency associated with fentanyl and stimulant use, as well as infections associated with black tar heroin.
The study’s limitations included its serial cross-sectional design, use of administrative coding, inability to directly link opioid use to amputation, and potential residual confounding from unmeasured clinical or behavioral risk factors.
“Amputation rates have increased among both opioid-related and nonopioid-related hospitalizations, with greater increases among opioid-related hospitalizations nationally and in the Northeast and West census regions,” wrote George Karandinos, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues.
The study was supported by National Institutes of Health/National Institute on Drug Abuse grants. Disclosure forms were available with the article online.
Source: Annals of Internal Medicine
